Managing osteoarthritis

Ensuring safety and optimization in total joint arthroplasty of cancer patients: A comprehensive analysis of complication risks and modifiable risk factors

Aims & objectives

The primary objective of this study is to determine whether an active cancer diagnosis results in an increased risk of perioperative TJA complications and postoperative mortality. The secondary objective is to analyze the effects of demographic factors on perioperative complication rates in cancer patients undergoing TJA.

Materials & methods

Patients with active cancer diagnoses undergoing total joint arthroplasty from 2014 to 2020 were included in this retrospective analysis. Patient data was obtained through ReachNet, which consisted of data from the University Medical Center, Tulane University Medical Center, Ochsner Health System, and Baylor Scott & White Health. ICD-9/10 codes were tagged for active cancer diagnoses within 365 days before surgery or 30 days after surgery to establish our active cancer population. Acute surgical complications within 30 days were identified by ICD codes.

Results

Patient demographics included predominantly male (51.5 %), white (83 %), and non-Hispanic (96.5 %) patients followed by black individuals (15.9 %) with 47.5 % of patients being smokers. Cancer patients did have a higher acute complication rate (2.6 % vs 1.7 %), but this difference was not significant (p = .139). This difference was higher but also not significant after adjustment (aOR = 1.32, 95 % CI = 0.71-2.43, p = .377). After adjustment, increased Charlson Comorbidity Index (CCI), white race and non-elective surgery were significant contributors to complication risk. Complication rates decreased significantly with year. Nonelective surgeries were also associated with higher complication rates (8.2 % vs. 1.8 %, p = .014).

Conclusion

Patients with active cancer diagnoses demonstrated higher unadjusted rates of TJA acute surgical complications and increased adjusted CCI when compared to non-cancer patients. Identifying risk factors and demographics correlated with increased perioperative complications may provide physicians with necessary information to avoid negative TJA outcomes in cancer patients.

In Vitro Engineered ECM-incorporated Hydrogels for Osteochondral Tissue Repair: A Cell-Free Approach

Prevalence of osteoarthritis has been increasing in aging populations, which has necessitated the use of advanced biomedical treatments. These involve grafts or delivering drug molecules entrapped in scaffolds. However, such treatments often show suboptimal therapeutic effects due to poor half-life and off-target effects of drug molecules. As a countermeasure, a 3D printable robust hydrogel-based tissue-repair platform is developed containing decellularized extracellular matrix (dECM) from differentiated mammalian cells as the therapeutic cargo. Here, pre-osteoblastic and pre-chondrogenic murine cells are differentiated in vitro, decellularized, and incorporated into methacrylated gelatin (GelMA) solutions to form osteogenic (GelO) and chondrogenic (GelC) hydrogels, respectively. Integrating the bioactive dECM from differentiated cell sources allows GelO and GelC to induce differentiation in human adipose-derived stem cells (hASCs) toward osteogenic and chondrogenic lineages. Further, GelO and GelC can be covalently adhered using a carbodiimide coupling reaction, forming a multi-layered hydrogel with potential application as a bioactive osteochondral plug. The designed multi-layered hydrogel can also induce differentiation of hASCs in vitro. In conclusion, the bioactive dECM carrying 3D printed robust hydrogel offers a promising new drug and cell-free therapeutic strategy for bone and cartilage repair and future osteoarthritis management.

Therapeutic Controlled Release Strategies for Human Osteoarthritis

Osteoarthritis is a progressive, irreversible debilitating whole joint disease that affects millions of people worldwide. Despite the availability of various options (non-pharmacological and pharmacological treatments and therapy, orthobiologics, and surgical interventions), none of them can definitively cure osteoarthritis in patients. Strategies based on the controlled release of therapeutic compounds via biocompatible materials may provide powerful tools to enhance the spatiotemporal delivery, expression, and activities of the candidate agents as a means to durably manage the pathological progression of osteoarthritis in the affected joints upon convenient intra-articular (injectable) delivery while reducing their clearance, dissemination, or side effects. The goal of this review is to describe the current knowledge and advancements of controlled release to treat osteoarthritis, from basic principles to applications in vivo using therapeutic recombinant molecules and drugs and more innovatively gene sequences, providing a degree of confidence to manage the disease in patients in a close future.

Geriatric drug delivery - barriers, current technologies and the road ahead

The geriatric population encompasses the largest part of the health care system worldwide. Chronic medical conditions are highly prevalent in the elderly, consequently, due to their complex health needs, there is a significant rate of multi-drug therapy. Despite the high numbers of medications prescribed, geriatric patients face several barriers when it comes to successful drug delivery including alterations in cognitive and physical function. The current review highlights the impact of chronic diseases on the ageing population along with how changes in drug pharmacokinetics could impact drug efficacy and safety. Also discussed are applications of administration routes in the geriatric population and complications that could arise. A focus is placed on the traditional and upcoming drug delivery advancements being employed in seniors with a focus addressing obstacles faced by this patient category. Nanomedicines, three-dimensional printing, long-acting formulations, transdermal systems, orally disintegrating tablets, and shape/taste modification technologies are discussed. Several barriers to drug delivery in the elderly have been identified in literature and directions for future studies should focus on addressing these gaps for geriatric drug formulation development including personalised medicine, insights into novel drug delivery systems like nanomedicines, methods for decreasing pill burden and shape/size modifications.ARTICLE HIGHLIGHTSTypically, senior citizens take more medications than any other patient population, yet most drug delivery technologies are not tailored to address the specific cognitive and physical barriers that these individuals encounter.The safety of drug delivery systems in the elderly patients should be prioritised with considerations on changes in pharmacokinetics with age, use of non-toxic excipients, and selecting drugs with minimal off-target side effects.Several commercialised and upcoming drug delivery technologies have begun to address the current limitations that the ageing population faces.Future research should focus on applying novel strategies like 3D printing, personalised medicine, and long-acting formulations to improve drug delivery to elderly patients.

How Well Do Studies of Mesenchymal Stem Cell Intervention and Knee Osteoarthritis Adhere to the Minimum Information for Studies Evaluating Biologics Guidelines? A Systematic Review of Randomized Controlled Trials

Background

The Minimum Information for Studies Evaluating Biologics in Orthopaedics (MIBO) guidelines for mesenchymal stem cell (MSC) research, published in 2017, contain a suggested checklist for reporting items in manuscripts involving MSCs.

Purpose

We sought to determine how well randomized controlled trials (RCTs) on MSC intervention for knee osteoarthritis (OA) adhered to the MIBO guidelines.

Methods

A comprehensive literature search was performed in the PubMed/MEDLINE and Web of Science databases. Inclusion criteria included English-only RCTs that assessed MSC intervention for knee OA published between 2018 and 2022. Metrics were extracted, including year of publication, study design, first author name, journal name, patient demographics, and MIBO checklist criteria.

Results

In 27 RCTs analyzed, 1006 patients were included, with a weighted male percentage of 41.8% and weighted mean age of 60.5 ± 7.2 years. On average, 70.5% (range, 30.2%-90.6%) of the modified 53-point MIBO checklist elements were reported per article. Seven (25.9%) articles had adherence rates of 80% or more, 13 (48.1%) had rates between 60% and 79.9%, and 7 (25.9%) had rates of 59.9% or less. The MIBO "intervention" category had the greatest adherence (100%), while the other categories had more variability. Six (50.0%) categories had an adherence level of 80% or more, 3 (25.0%) had adherence levels of 60% to 79.9%, and 3 (25.0%) had an adherence level of 59.9% or less.

Conclusion

The overall mean adherence to MIBO guidelines of RCTs on MSC intervention for knee OA was 70.5%. Authors should better integrate the MIBO guidelines into their methodology to improve transparency, reproducibility, and reporting.

Efficacy, safety and tolerability of GSK3858279, an anti-CCL17 monoclonal antibody and analgesic, in healthy volunteers and patients with knee osteoarthritis pain: a phase I, randomised, double-blind, placebo-controlled, proof-of-mechanism and proof-of-concept study

OBJECTIVES

The objective of this study was to evaluate efficacy, safety and tolerability of the first-in-class, anti-CCL17 monoclonal antibody, GSK3858279, in treating knee osteoarthritis (OA) pain.

METHODS

This was a phase I, randomised, placebo-controlled, two-part, proof-of-mechanism and proof-of-concept study. In part A, healthy participants were randomised 3:1 to receive GSK3858279 as either single intravenous (0.1-10 mg/kg) doses, a subcutaneous (3 mg/kg up to 240 mg maximum) dose, or placebo, to evaluate safety and tolerability. In part B, participants with knee OA pain were randomised 1:1 to receive weekly subcutaneous 240 mg GSK3858279, or placebo, for 8 weeks, to assess safety and change from baseline (CFB) in average and worst knee pain intensity. Exploratory endpoints included CFB in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, function and stiffness scores.

RESULTS

GSK3858279 demonstrated greater median CFB (95% credible interval (CrI)) in average and worst knee pain intensity versus placebo (average, -1.18 (-2.15, -0.20); worst, -1.09 (-2.29, 0.12)) at week 8. Median CFB (95% CrI) for GSK3858279 versus placebo in WOMAC pain and function scores were -1.41 (-2.35, -0.46) and -1.29 (-2.28, -0.29), respectively, at week 8. Overall, 72% (26/36; part A) and 88% (21/24; part B) of participants receiving GSK3858279 experienced adverse events (AEs); with nasopharyngitis being the most common in part A and injection site reactions in part B. No serious AEs or deaths were observed.GSK3858279 improved pain intensity and WOMAC pain and function scores in adults with knee OA pain and demonstrated favourable safety and tolerability in both healthy participants and adults with knee OA pain.

Effects of resveratrol on biochemical and structural outcomes in osteoarthritis: A systematic review and meta-analysis of preclinical studies

Background and objective

Osteoarthritis (OA) is the most common age-related disease of joints with increasing global prevalence. Persistent inflammation within the joint space is speculated to be the cause of OA. Resveratrol is an anti-inflammatory and antioxidant compound which can influence cartilage metabolism through multiple signalling pathways. This systematic review and meta-analysis aimed to summarize the therapeutic effects of resveratrol in animal models of OA.

Methods

A comprehensive literature search was performed using PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, China Wanfang and VIP databases in May 2023. Studies on the effects of resveratrol in animal models of OA written in English or Mandarin, published from the inception of databases until the date of the search were considered.

Results

Fifteen eligibility studies were included and analysed. Resveratrol was shown to inhibit the secretion of interleukin-1β, tumour necrosis factor-α, interleukin-6, nitric oxide, and apoptosis of articular chondrocytes. Joint structure as indicated by Mankin scores was restored with resveratrol in animal OA models.

Conclusion

Resveratrol is a potential therapeutic agent for OA based on animal studies. Further evidence from well-planned human studies would be required to validate its clinical efficacies.

Impact of Cuminaldehyde and Indomethacin Co-Administration on Inflammatory Responses in MIA-Induced Osteoarthritis in Rats

Osteoarthritis (OA) remains a chronic incurable condition, presenting substantial challenges in treatment. This study explores a novel strategy by investigating the concurrent use of cuminaldehyde, a natural compound, with indomethacin in animal models of MIA-induced OA. Our results demonstrate that the co-administration of cuminaldehyde and indomethacin does indeed produce a superior effect when compared to these compounds individually, significantly enhancing therapeutic outcomes. This effect is evidenced by a marked reduction in pro-inflammatory cytokines IL-6 and IFN-γ, alongside a significant increase in the anti-inflammatory cytokine IL-10, compared to treatments with each compound alone. Radiographic analyses further confirm the preservation of joint integrity and a reduction in osteoarthritic damage, highlighting the association's efficacy in cartilage-reducing damage. These findings suggests that the association of cuminaldehyde and indomethacin not only slows OA progression but also offers enhanced cartilage-reducing damage and fosters the production of protective cytokines. This study underscores the potential benefits of integrating natural products with pharmaceuticals in OA management and stresses the importance of further research to fully understand the mechanisms underlying the observed potentiated effects.

Randomized Controlled Trials on Platelet-Rich Plasma for Knee Osteoarthritis Poorly Adhere to the Minimum Information for Studies Evaluating Biologics in Orthopaedics (MIBO) Guidelines: A Systematic Review

BACKGROUND

Platelet-rich plasma (PRP) treatment for knee osteoarthritis has grown exponentially over the past decade; however, its scientific evaluation is highly variable. The American Academy of Orthopaedic Surgeons addressed the need for the standardization of orthobiologics studies by publishing the Minimum Information for Studies Evaluating Biologics in Orthopaedics (MIBO) guidelines in May 2017. In total, the MIBO guidelines are divided into 12 categories, encompassing 23 checklist items.

HYPOTHESIS/PURPOSE

The purpose of this study was to analyze how well randomized controlled trials (RCTs) on PRP interventions for knee osteoarthritis adhered to the MIBO guidelines. We hypothesized that most articles would report <80% of the MIBO criteria.

STUDY DESIGN

Systematic review; Level of evidence, 1.

METHODS

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to perform a systematic review in the PubMed/MEDLINE and Web of Science databases. Inclusion criteria included English-language RCTs that assessed PRP interventions for knee osteoarthritis and reported beginning patient enrollment in June 2017 or later. The original 23 MIBO checklist items were separated and modified into a 44-point checklist. Adherence was determined by calculating the total percentage of checklist items that each article adequately and clearly reported from the 44-point checklist.

RESULTS

A total of 25 RCTs (2356 patients) were included in this study. The weighted mean age was 57.7 ± 4.4 years, with 42.9% being male. On average, only 53.1% ± 10.4% (range, 31.8%-77.3%) of the 44-point MIBO checklist items were reported per article. No articles had adherence rates ≥80%, 5 (20.0%) had rates between 60% and 79.9%, and 20 (80.0%) had rates ≤59.9%. Categories fluctuated in adherence, with "Intervention" having the greatest adherence (100.0%) and "Activation" having the lowest (14.0%). Additionally, 4 (33.3%) categories had adherence rates ≥80%, 0 had rates from 60% to 79.9%, and 8 (66.7%) had rates ≤59.9%.

CONCLUSION

The overall mean adherence to MIBO guidelines by RCTs on PRP interventions for knee osteoarthritis was 53.1%. To increase the reproducibility, improve transparency, and assess the treatment efficacy of future PRP studies, reporting of MIBO guidelines should be improved.

The effectiveness of therapeutic ultrasound to the mechanically damaged chondrocyte culture

OBJECTIVE

This study aimed to evaluate the efficacy of low intensity (0.1-0.8 Watt/cm2) pulsed ultrasound on chondrocyte cell proliferation and migration.

METHODS

Low-intensity pulsed ultrasound (frequency 3 MHz, duty cycle 25%, and pulse repetition frequency 150 Hz) for 5 minutes at different spatial average intensities was applied on chondrocyte cells. First, the optimum dose with significantly increased proliferation was determined to be 0.5 W/cm2 for 5 minutes of duration. Then, 0.5 W/cm2 ultrasound intensity was applied for durations of 2.5, 5, 7.5, and 10 minutes, and healing was assessed by monitoring cell migration and proliferation.

RESULTS

At the intensity of 0.5 W/cm2 48 hours after the application, a statistically significant increase in proliferation (p = .0089) was observed in chondrocyte cells compared to the control group. Proliferation was analyzed at 4, 8, 24, and 48 hours after applying 0.5 W/cm2 ultrasound for durations of 2.5, 5, 7.5, and 10 minutes. Statistically significant increases were observed at 4 hours (p = .009), 8 hours (p = .032), 24 hours (p = .0084), and 48 hours (p = .00098) with 10 minutes of exposure. For 7.5 min of exposure duration, significant increases were observed at 48 hours (p = .045). In migration for all parameters, no statistically significant improvement (p > .05) was observed.

CONCLUSION

It was shown that low intensity pulsed ultrasound induces cartilage cell proliferation; therefore, it may have a disease-modifying effect in the treatment of osteoarthritis. However, no positive effect was observed on cartilage cell migration.

Structural and Molecular Changes of Human Chondrocytes Exposed to the Rotating Wall Vessel Bioreactor

Over the last 30 years, the prevalence of osteoarthritis (OA), a disease characterized by a loss of articular cartilage, has more than doubled worldwide. Patients suffer from pain and progressive loss of joint function. Cartilage is an avascular tissue mostly consisting of extracellular matrix with embedded chondrocytes. As such, it does not regenerate naturally, which makes an early onset of OA prevention and treatment a necessity to sustain the patients' quality of life. In recent years, tissue engineering strategies for the regeneration of cartilage lesions have gained more and more momentum. In this study, we aimed to investigate the scaffold-free 3D cartilage tissue formation under simulated microgravity in the NASA-developed rotating wall vessel (RWV) bioreactor. For this purpose, we cultured both primary human chondrocytes as well as cells from the immortalized line C28/I2 for up to 14 days on the RWV and analyzed tissue morphology, development of apoptosis, and expression of cartilage-specific proteins and genes by histological staining, TUNEL-assays, immunohistochemical detection of collagen species, and quantitative real-time PCR, respectively. We observed spheroid formation in both cell types starting on day 3. After 14 days, constructs from C28/I2 cells had diameters of up to 5 mm, while primary chondrocyte spheroids were slightly smaller with 3 mm. Further inspection of the 14-day-old C28/I2 spheroids revealed a characteristic cartilage morphology with collagen-type 1, -type 2, and -type 10 positivity. Interestingly, these tissues were less susceptible to RWV-induced differential gene expression than those formed from primary chondrocytes, which showed significant changes in the regulation of IL6, ACTB, TUBB, VIM, COL1A1, COL10A1, MMP1, MMP3, MMP13, ITGB1, LAMA1, RUNX3, SOX9, and CASP3 gene expression. These diverging findings might reflect the differences between primary and immortalized cells. Taken together, this study shows that simulated microgravity using the RWV bioreactor is suitable to engineer dense 3D cartilage-like tissue without addition of scaffolds or any other artificial materials. Both primary articular cells and the stable chondrocyte cell line C28/I2 formed 3D neocartilage when exposed for 14 days to an RWV.

Effects of externally-applied, non-pharmacological Interventions on short- and long-term symptoms and inflammatory cytokine levels in patients with knee osteoarthritis: a systematic review and network meta-analysis

Background

With the continuous development of clinical medicine, an increasing number of non-pharmacological interventions have been applied for the treatment of knee osteoarthritis (KOA), with the results of several recent randomized controlled trials (RCTs) showing that a variety of externally-applied, non-pharmacological interventions (EANPI) can improve symptoms and inflammation in patients with KOA. However, the relative benefits and disadvantages of non-drug therapies remain uncertain, and an optimal treatment strategy has not yet been determined.

Objective

This study applied network meta-analysis (NMA) to compare and rank the effectiveness of EANPI on the short- and long-term clinical symptoms and inflammatory cytokine levels in patients with KOA.

Methods

Two independent researchers searched online databases and performed manual retrieval of related citations to identify RCTs that met the selection criteria for the network meta-analysis. These researchers retrieved studies indexed from database inception to August 2023 and performed data extraction and assessment of the risk of bias.

Results

The analysis included 80 RCTs involving 8440 participants and nine externally-applied, non-pharmacological therapies, namely extracorporeal shock wave, radiofrequency, acupotomy, laser therapy, Tuina therapy, kinesio taping, electroacupuncture, platelet-rich plasma injection, and ozone therapy. The treatment courses ranged from 1 to 12 weeks, with follow-up periods ranging from 4 to 24 weeks. The results of the NMA indicated that each non-drug therapy was superior to sham intervention in improving all outcome indicators. Except for the visual analog scale (VAS) and Western Ontario MacMaster (WOMAC) pain outcomes, all non-drug therapies had better efficacy than pharmacological treatments. For short-term VAS and tumor necrosis factor-alpha (TNF-α), extracorporeal shock wave performed better than other therapies (90.2% and 85.2% respectively). Radiofrequency therapy may be the most promising method to reduce long-term VAS, short- and long-term WOMAC pain, and interleukin (IL)-1β level (84.8%, 97.8%, 90.1%, 94.8% respectively). Tuina therapy may be a significant choice for short- and long-term outcomes of WOMAC function and range of motion (ROM).

Conclusions

The results of the comprehensive comparison of the outcome indicators in 9 different EANPI indicated that radiofrequency and Tuina therapy were more effective and consistently ranked high in improving clinical symptoms in the short and long term. Radiofrequency is effective at relieving pain, and Tuina therapy can be given priority for treatment when hypofunction is the main symptom. EANPI to improve pain symptoms may be related to the regulation of inflammatory cytokine levels, which may be a potential mechanism of action.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?, identifier CRD42023464177.

Development of a New Benzofuran-Pyrazole-Pyridine-Based Molecule for the Management of Osteoarthritis

Osteoarthritis is a substantial burden for patients with the disease. The known medications for the disease target the mitigation of the disease's symptoms. So, drug development for the management of osteoarthritis represents an important challenge in the medical field. This work is based on the development of a new benzofuran-pyrazole-pyridine-based compound 8 with potential anti-inflammatory and anti-osteoarthritis properties. Microanalytical and spectral data confirmed the chemical structure of compound 8. The biological assays indicated that compound 8 produces multifunctional activity as an anti-osteoarthritic candidate via inhibition of pro-inflammatory mediators, including RANTES, CRP, COMP, CK, and LPO in OA rats. Histopathological and pharmacokinetic studies confirmed the safety profile of the latter molecule. Accordingly, compound 8 is considered a promising anti-osteoarthritis agent and deserves deeper investigation in future trials.

Comparative effectiveness of moxibustion and acupuncture for the management of osteoarthritis knee: A systematic review and meta-analysis

Background

Moxibustion, a traditional Chinese medicine approach, stimulates blood circulation by burning wormwood at acupuncture points and is frequently used in conjunction with acupuncture for managing knee osteoarthritis. This review aims to compare the effectiveness of moxibustion and acupuncture in the management of knee osteoarthritis.

Methods

Our team conducted a comprehensive search across several databases: PubMed Central, EMBASE, MEDLINE, the Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), and the Cochrane Library, covering the timeframe from January 1964 up until April 2022. We implemented a meta-analysis, utilizing a random-effects model, and we've presented the pooled standardized mean difference (SMD) and risk ratio (RR) inclusive of the 95% confidence intervals (CIs), in accordance with the nature of the outcome.

Results

21 studies were included, of which, half were identified as having high risk of bias. The pooled SMD for the pain score was found to be -0.53 (95% CI: -0.91 to -0.15). In-depth analysis focusing on the kind of moxibustion indicated that fire needle moxibustion was more effective in pain reduction (SMD = -0.56; 95% CI: -1.10 to -0.01) compared to alternative moxibustion methods (SMD = -0.47; 95% CI: -0.80 to -0.13). The pooled RR for the success rate in treatment was 1.39 (95% CI: 1.19 to 1.62). Subgroup analysis demonstrated that fire needle moxibustion reported a superior success rate (RR = 1.43; 95% CI: 1.19 to 1.72) in comparison to other types of moxibustion (RR = 1.33; 95% CI: 1.02 to 1.74).

Conclusion

Moxibustion, specifically fire needle moxibustion, demonstrated superior effectiveness in managing knee osteoarthritis compared to acupuncture.

The Role of Regulated Programmed Cell Death in Osteoarthritis: From Pathogenesis to Therapy

Osteoarthritis (OA) is a worldwide chronic disease that can cause severe inflammation to damage the surrounding tissue and cartilage. There are many different factors that can lead to osteoarthritis, but abnormally progressed programmed cell death is one of the most important risk factors that can induce osteoarthritis. Prior studies have demonstrated that programmed cell death, including apoptosis, pyroptosis, necroptosis, ferroptosis, autophagy, and cuproptosis, has a great connection with osteoarthritis. In this paper, we review the role of different types of programmed cell death in the generation and development of OA and how the different signal pathways modulate the different cell death to regulate the development of OA. Additionally, this review provides new insights into the radical treatment of osteoarthritis rather than conservative treatment, such as anti-inflammation drugs or surgical operation.

Cuminaldehyde Effects in a MIA-Induced Experimental Model Osteoarthritis in Rat Knees

Osteoarthritis (OA) is a chronic degenerative disease that has a significant global impact. It is associated with aging and characterized by widespread joint destruction. Cuminaldehyde is a biologically active component of essential oils that has shown promise in the treatment of nociceptive and inflammatory diseases. This study investigated the effects of cuminaldehyde on an experimental model of osteoarthritis induced in rat knees. Cuminaldehyde was found to be as effective as indomethacin in reducing pain in all evaluated tests, including forced walking, functional disability of weight distribution on the legs, and spontaneous pain in animals with osteoarthritis. The knees of animals treated with cuminaldehyde had significantly higher radiographic and histopathological scores than those of animals that did not receive the treatment. Cuminaldehyde also modulated the production of pro-inflammatory cytokines. In vitro assays showed that cuminaldehyde preferentially inhibits COX-2 enzyme activity. In silico studies demonstrated that cuminaldehyde has satisfactory energy affinity parameters with opioid receptors and COX-2. These findings suggest that cuminaldehyde's anti-inflammatory activity is multifactorial, acting through multiple pathways. Its nociceptive activity occurs via central and peripheral mechanisms. Cuminaldehyde modulates the immune response of the inflammatory process and may be considered a leading compound for the development of new anti-inflammatory and analgesic drugs.

Effects of medications on incidence and risk of knee and hip joint replacement in patients with osteoarthritis: a systematic review and meta-analysis

Background

This systematic review and meta-analysis aimed to investigate the incidence and risk of knee and hip replacement in patients with osteoarthritis (OA) treated with different medications.

Methods

OVID MEDLINE, OVID EMBASE, Cochrane and Web of Science electronic databases were searched from inception to May 4th, 2022. Clinical trials, including randomized controlled trials, cohort studies and case–control studies, were selected. The meta-analysis effect size was estimated using either incidence with 95% confidence intervals (CIs) or odds ratio (OR)/relative risk (RR) with 95% CIs. The risk of bias and heterogeneity among studies were assessed and analyzed.

Results

Forty studies were included, involving 6,041,254 participants. The incidence of joint replacement in patients with OA varied according to the study design and treatments. The incidence of knee arthroplasty varied from 0 to 70.88%, while the incidence of hip arthroplasty varied from 11.71 to 96.43%. Compared to non-users, bisphosphonate users had a reduced risk of knee replacement (RR = 0.71, 95% CI: 0.66–0.77; adjusted hazard ratio [aHR] = 0.76, 95% CI: 0.70–0.83). Compared to intra-articular corticosteroid users, hyaluronic acid (HA) users had a higher risk of knee arthroplasty (RR = 1.76, 95% CI: 1.38–2.25). No publication bias was observed.

Conclusions

Bisphosphonate treatment is associated with a reduced risk of knee replacement. More studies are needed to validate our results due to the limited number of eligible studies and high heterogeneity among studies.

Patellofemoral arthroplasty in combination with high tibial osteotomy can achieve good outcome for patients with medial-patellofemoral osteoarthritis

Background

The purpose of our study is to report on the clinical outcomes of patients who undergoing patellofemoral arthroplasty (PFA) in combination with a high tibial osteotomy (HTO). Due to this procedure's conservative and kinematics-preserving characteristics, we hypothesized that PFA in combination with HTO would result in good clinical outcomes in patients with medial and patellofemoral compartment osteoarthritis (MPFOA).

Methods

Patients who underwent PFA in combination with HTO for MPFOA from January 2018 to April 2020 were included in the study. Clinical outcomes were analyzed by comparing the Knee Society Score, Oxford Knee Score, Range of Motion, and Forgotten Joint Score before and after the procedure. Radiological evaluations were also performed to assess the tibiofemoral osteoarthritis progression and implant loosening. For all tests, the value of p < 0.05 was considered statistically significant.

Results

A total of nine consecutive patients who underwent PFA in combination with HTO were included. Two were males, seven were females. The average follow-up period was 2.6 ± 0.4 years. Clinical outcomes showed a significant improvement in the Knee Society Score (clinical score: 90.3 ± 8.5 and function score: 90.8 ± 7.8), Oxford Knee Score (43.6 ± 3.6), Forgotten Joint Score (71.2 ± 10.2), and knee Range of Motion (130.4 ± 8.1°) at the final follow-up. Additionally, hip-knee-ankle angle significantly decreased from -9.3 ± 2.1° preoperatively to 2.2 ± 1.2° at the final follow-up (p < 0.05). There were no complications for any patient during the follow-up time.

Conclusion

This study shows that patients who underwent PFA in combination with HTO for the treatment of MPFOA achieved good clinical and radiological outcomes. This combined surgery could be an effective alternative to treat MPFOA in well-selected patients.

Natural Compounds Affecting Inflammatory Pathways of Osteoarthritis

Osteoarthritis (OA) is the most common type of arthritis and chronic joint disease, affecting more than 240 million people worldwide. Although there are numerous advances in using drugs in treating OA, the use of natural compounds has aroused much interest among researchers due to their safety margin. Recent discovery shows that natural compounds play an extensive role in the oxidative stress signaling pathway in treating OA. Thus, this review summarizes the commonly used natural compounds for treating OA focusing on the oxidative stress signaling pathway and its downstream mediators. Selected databases—such as Scopus, Web of Science, Nature, and PubMed—were used to search for potentially relevant articles. The search is limited to the last 15 years and the search was completed using the Boolean operator’s guideline using the keywords of natural product AND oxidative stress AND osteoarthritis OR natural extract AND ROS AND degenerative arthritis OR natural plant AND free radicals AND degenerative joint disease. In total, 37 articles were selected for further review. Different downstream mechanisms of oxidative stress involved in the usage of natural compounds for OA treatment and anabolic and catabolic effects of natural compounds that exhibit chondroprotective effects have been discussed with the evidence of in vitro and in vivo trials in this review.

A Comprehensive Update of Prolotherapy in the Management of Osteoarthritis of the Knee

This is a comprehensive review of the literature focusing on the use of prolotherapy in the treatment of osteoarthritis of the knee. It covers the background, efficacy, and advantages of prolotherapy in the management of osteoarthritis symptoms and then covers the existing evidence of the use of prolotherapy for this purpose. Current treatments for osteoarthritis of the knee are numerous, yet patients continue to endorse chronic pain and poor quality of life. Prolotherapy is a treatment that has been inadequately studied with poor sample sizes and lack of standardization between trials. However, in recent years the literature on prolotherapy in the treatment of knee osteoarthritis has grown. Although there is still a lack of homogeneity, trials have shown that dextrose prolotherapy, autologous conditioned serum, hyaluronic injections, and normal saline administered either intra- or peri-articularly are comparable in reducing pain scores to other primary treatment options. The mechanism of action for prolotherapy is still unclear, but researchers have found that prolotherapy plays some role in cartilage growth or chondrogenesis and has been shown to have improved radiographic outcomes. Prolotherapy appears to be a safe treatment alternative that has been shown to improve stiffness, pain, function, and quality of life in osteoarthritis of the knee. Knee osteoarthritis is remarkably prevalent in the United States and is one of the most common causes of disability in the elderly population. Although there are many treatment options, patients continue to live with chronic pain which can incur high costs for patients. A safe, long-term, and effective solution has not yet been identified. Prolotherapy has been shown to be a safe option for improving pain, function, and quality of life as effectively as other treatment options.

Content, Structure and Delivery Characteristics of Yoga Interventions for the Management of Osteoarthritis: A Systematic Review Protocol

The global burden of osteoarthritis among adults is rising. Yoga might be a potential solution for the management of osteoarthritis. This systematic review aims to synthesise the content, structure and delivery characteristics of effective yoga interventions for the management of osteoarthritis. The JBI methodology for systematic reviews of effectiveness and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines will be followed. Randomised controlled trials (RCTs) assessing the effectiveness of yoga interventions for the management of osteoarthritis in adults will be included in this review. We aim to search the following databases to find published and unpublished studies: MEDLINE, EMBASE, CINAHL, PsycInfo, SPORTDiscus, AMED, Web of Science, CENTRAL, TRIP, AYUSH Research Portal, ABIM, CAM-QUEST, PeDro, OpenGrey, EthOS, ProQuest Dissertations and Theses and DART-Europe-e-theses portal. No date or language restrictions will be applied. A narrative synthesis will be conducted with the help of tables. A meta-regression will be conducted to explore the statistical evidence for which the components (content, structure and delivery characteristics) of yoga interventions are effective.

The effect of physical therapy and exercise on pain and functional capacity according to the radiological grade of knee osteoarthritis

BACKGROUND

Physical therapy and exercise programs are frequently used in the treatment of knee osteoarthritis (OA). However, it is not known at what stage of knee OA it is more effective.

OBJECTIVE

The purpose of this work was to determine the relationship between the effectiveness of the physical therapy and exercise programs and the radiological findings presence/grade of knee OA.

MATERIAL AND METHODS

Overall, 92 patients (65F, 27M) with knee OA were enrolled in the retrospective study. Standard knee radiographs were graded according to Kellgren-Lawrence. Pain and functional status were evaluated using a visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline, at the end of the physical therapy program (first month), and at third-month control visits. The demographic characteristics and VAS/WOMAC scores of the subjects were obtained from patient files.

RESULTS

We analyzed 131 knees of 92 patients with knee OA (65F, 27M, mean age 53.02 ± 11.13 years). The mean total VAS and WOMAC scores on the first and third months were significantly lower than the initial values (all p< 0.001). The mean VAS scores on the first and third months were significantly lower than the initial values in the group without radiological damage, but WOMAC scores were similar between the evaluations (p= 0.009, p 50 = 0.003, respectively). The mean VAS and WOMAC scores on the first and third months were significantly lower than the initial values in the grade 1 according to the Kellgren-Lawrence radiological grades (all p< 0.001).

CONCLUSIONS

According to the results of our study, physical therapy and exercise was effective on pain in all patients with knee OA, but only effective on knee functional capacity in the group with radiological findings, and especially more effective in patients with Kellgren-Lawrence grade 1.

The lncRNA MIAT/miR-181a-5p axis regulates osteopontin (OPN)-mediated proliferation and apoptosis of human chondrocytes in osteoarthritis

Osteoarthritis (OA) is a slow-progressing degenerative joint disease mainly characterized by progressive cartilage loss and subchondral bone remodeling. Osteopontin (OPN) is a matrix extracellular glyco-phosphoprotein capable of regulating the expression levels of multiple factors linked with OA pathogenesis. This study explores the upstream regulatory molecular mechanism of OPN on proliferation and apoptosis of human chondrocytes in OA. Chondrocytes were isolated from OA cartilage and identified by toluidine blue staining and immunofluorescent staining of type II collagen. An MTT assay was used for cell viability, and a BrdU assay was applied for DNA synthesis. Cell apoptosis was detected by a flow cytometry assay. A lncRNA MIAT/miR-181a-5p/OPN axis regulating OA chondrocyte proliferation and apoptosis were identified. miR-181a-5p directly targeted OPN and inhibited OPN expression in OA chondrocytes. miR-181a-5p overexpression inhibited OA chondrocyte viability, suppressed DNA synthesis, and promoted apoptosis. OPN overexpression exerted opposite effects on OA chondrocytes and significantly attenuated the roles of miR-181a-5p overexpression in OA chondrocytes. A total of six long non-coding RNAs (lncRNAs) were predicted to target miR-181a-5p, and MIAT was the most up-regulated in OA cartilage tissues among the six lncRNAs. Through direct targeting, MIAT inhibited miR-181a-5p expression. MIAT silencing inhibited cell viability, suppressed DNA synthesis, and promoted cell apoptosis. Moreover, miR-181a-5p inhibition partially reversed the effects of MIAT silencing on OA chondrocytes. The lncRNA MIAT/miR-181a-5p/OPN axis could modulate OA chondrocyte proliferation and apoptosis. The comprehensive function of this axis on OA requires further in vivo and clinical investigations.

PVA-Based Hydrogels Loaded with Diclofenac for Cartilage Replacement

Polyvinyl alcohol (PVA) hydrogels have been widely studied for cartilage replacement due to their biocompatibility, chemical stability, and ability to be modified such that they approximate natural tissue behavior. Additionally, they may also be used with advantages as local drug delivery systems. However, their properties are not yet the most adequate for such applications. This work aimed to develop new PVA-based hydrogels for this purpose, displaying improved tribomechanical properties with the ability to control the release of diclofenac (DFN). Four types of PVA-based hydrogels were prepared via freeze-thawing: PVA, PVA/PAA (by polyacrylic acid (PAA) addition), PVA/PAA+PEG (by polyethylene glycol (PEG) immersion), and PVA/PAA+PEG+A (by annealing). Their morphology, water uptake, mechanical and rheological properties, wettability, friction coefficient, and drug release behavior were accessed. The irritability of the best-performing material was investigated. The results showed that the PAA addition increased the swelling and drug release amount. PEG immersion led to a more compact structure and significantly improved the material’s tribomechanical performance. The annealing treatment led to the material with the most suitable properties: besides presenting a low friction coefficient, it further enhanced the mechanical properties and ensured a controlled DFN release for at least 3 days. Moreover, it did not reveal irritability potential for biological tissues.

An up to date on clinical prospects and management of osteoarthritis

The rising prevalence of osteoarthritis (OA) in the general population has necessitated the development of novel treatment options. It is critical to recognize the joint as a separate entity participating in degenerative processes, as well as the multifaceted nature of OA. OA is incurable because there is currently no medication that can stop or reverse cartilage or bone loss. As this point of view has attracted attention, more research is being directed toward determining how the various joint components are impacted and how they contribute to OA pathogenesis. Over the next few years, several prospective therapies focusing on inflammation, cartilage metabolism, subchondral bone remodelling, cellular senescence, and the peripheral nociceptive pathway are predicted to transform the OA therapy landscape. Stem cell therapies and the use of various biomaterials to target articular cartilage (AC) and osteochondral tissues are now being investigated in considerable detail. Currently, laboratory-made cartilage tissues are on the verge of being used in clinical settings. This review focuses on the update of clinical prospects and management of osteoarthritis, as well as future possibilities for the treatment of OA.

•

Osteoarthritis (OA) is a general term that incorporates several different joint diseases.

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The exact pathophysiology of OA remains unclear.

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OA is incurable because there is currently no medication that can stop or reverse cartilage or bone loss.

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Nonsteroidal anti-inflammatory drugs are the most frequently prescribed medications to alleviate arthritic discomfort.

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Stem cell therapies to target articular cartilage and osteochondral tissues are now under investigation.

Return to Work Following Isolated Opening Wedge High Tibial Osteotomy

PURPOSE

Patients with isolated medial compartment osteoarthritis and varus deformity may undergo high tibial osteotomy (HTO) to reduce the contact pressure in the medial compartment. The purpose of this investigation is (1) examine the timeline of return to work (RTW) following HTO and (2) evaluate RTW stratified by occupational intensity.

METHODS

Consecutive patients undergoing HTO were reviewed retrospectively at a minimum of 2-years postoperatively. Patients completed a subjective work questionnaire, a visual analogue scale for pain, Single Assessment Numerical Evaluation, and a satisfaction questionnaire.

RESULTS

Thirty-eight patients were included at an average of 9.0 ± 3.3 years postoperatively. Thirty-seven patients (average age 43.4 ± 7.8 years, 91.9% with a Kellgren-Lawrence grade of III/IV) were employed within 3 years prior to surgery. Eighteen patients (48.6%) underwent subsequent surgery with 14 patients (37.8%) receiving a salvage knee arthroplasty at an average of 6.1 ± 3.5 years following HTO. Thirty-five patients (94.5%) returned to work at an average of 2.9 ± 2.0 months. The rate of RTW for sedentary, light, moderate, and heavy duties were 87.5%, 100%, 100%, and 93.3%, respectively, while the duration until RTW was 1.0 months, 1.1 months, 2.4 months, and 3.3 months, respectively.

CONCLUSION

In a young and active population with osteoarthritis or varus deformity, an HTO allows patients to return to work; however, patients with high-intensity occupations may be absent from work longer than those with lesser physically demanding occupations. HTO is not a definitive treatment option as nearly 40% of patients underwent knee arthroplasty by 6.1 years postoperatively.

LEVEL OF EVIDENCE

IV, case series.

Osteoblast Dysfunction in Non-Hereditary Sclerosing Bone Diseases

A review of the available literature was performed in order to summarize the existing evidence between osteoblast dysfunction and clinical features in non-hereditary sclerosing bone diseases. It has been known that proliferation and migration of osteoblasts are concerted by soluble factors such as fibroblast growth factor (FGF), platelet-derived growth factor (PDGF), transforming growth factor (TGF), bone morphogenetic protein (BMP) but also by signal transduction cascades such as Wnt signaling pathway. Protein kinases play also a leading role in triggering the activation of osteoblasts in this group of diseases. Post-zygotic changes in mitogen-activated protein kinase (MAPK) have been shown to be associated with sporadic cases of Melorheostosis. Serum levels of FGF and PDGF have been shown to be increased in myelofibrosis, although studies focusing on Sphingosine-1-phosphate receptor was shown to be strongly expressed in Paget disease of the bone, which may partially explain the osteoblastic hyperactivity during this condition. Pathophysiological mechanisms of osteoblasts in osteoblastic metastases have been studied much more thoroughly than in rare sclerosing syndromes: striking cellular mechanisms such as osteomimicry or complex intercellular signaling alterations have been described. Further research is needed to describe pathological mechanisms by which rare sclerosing non hereditary diseases lead to osteoblast dysfunction.

Mass Spectrometry-based Biomarkers for Knee Osteoarthritis: A Systematic Review

Introduction: Knee osteoarthritis (OA) is a joint disease, affecting multiple tissues in the joint. Early detection and intervention may delay OA development and avoid total knee arthroplasty. Specific biomarker profiles for early detection and guiding clinical decision-making of OA have not yet been identified. One technique that can contribute to the finding of this "OA biomarker" is mass spectrometry (MS), which offers the possibility to analyze different molecules in tissues or fluids. Several proteomic, lipidomic, metabolomic and other -omic approaches aim to identify these molecular profiles; however, variation in methods and techniques complicate the finding of promising candidate biomarkers.Areas covered: In this systematic review, we aim to provide an overview of molecules in OA knee patients. Possible biomarkers in several tissue types of OA and non-OA patients, as well as current limitations and possible future suggestions will be discussed.Expert opinion: According to this review, we do not believe one specific biomarker will function as predictive molecule for OA. Likely, a group of molecules will give insight in OA development and possible therapeutic targets. For clinical implementation of MS-analysis in clinical decision-making, standardized procedures, large cohort studies and sharing protocols and data is necessary.

The Effectiveness of Anti-Nerve Growth Factor Monoclonal Antibodies in the Management of Pain in Osteoarthritis of the Hip and Knee: A PRISMA Systematic Review and Meta-Analysis

OBJECTIVE

To conduct a systematic review and meta-analysis of the efficacy of anti-nerve growth factor (NGF) monoclonal antibodies in osteoarthritis pain (hip and knee).

DESIGN

Grade the evidence for anti-NGF use.

METHODS

An interdisciplinary work group conducted a literature search for anti-NGF use in osteoarthritis. The systematic review was performed in accordance with methods described by the Cochrane collaboration. General inclusion criteria included all osteoarthritis trials studying any monoclonal anti-NGF antibody at any dose/phase. Excluded studies were those where participants received NSAIDs or analgesics other than anti-NGF antibodies. The Jadad Scale score was used to assess the quality of the included studies.

RESULTS

Thirteen studies were included in the analysis, involving 8145 participants with a diagnosis of hip and/or knee osteoarthritis. Anti-NGF antibody treatment was associated with a significant improvement in all Western Ontario and McMaster Universities Arthritis Index (WOMAC) indices when compared to placebo. These agents were not associated with a significantly increased incidence of serious adverse events but were associated with significant increases in therapy discontinuation due to adverse events or side effects (e.g., peripheral neuropathy).

CONCLUSIONS

Future randomized clinical trials are needed to characterize the overall risk-to-benefit ratio of anti-NGF antibodies in managing pain associated with OA, particularly with long-term use, in order to verify their efficacy and safety in clinical practice.

Curcumin and Freshwater Clam Extracts Alleviate the Progression of Osteoarthritis by Reducing Synovial Inflammation and Allowing Cartilage Regeneration

Osteoarthritis (OA) is a common degenerative disorder and is accompanied by numerous pain symptoms. With increased age, individuals develop a chronic inflammatory status, and pro-inflammatory cytokines as well as mediators contribute to the progression of OA. However, no desirable remedies have been completely able to inhibit OA progression or safely provide effective symptomatic relief. Natural component extracts or dietary-derived compounds are widely used for anti-inflammatory diseases. Curcumin and freshwater clam extract (FCE) have been proven as functional foods that are able to regulate immune systems. This study demonstrated that curcumin and FCE had synergistic effects on alleviating the progression of OA by assuaging inflammation and repairing the cartilage within the joints. After consumption of curcumin and FCE, the severity of synovitis was quantified by the infrapatellar fat pad inflammation scoring system and the Osteoarthritis Research Society International (OARSI) scoring system. Significant improvement and articular cartilage regeneration were noted. Moreover, once the inflammation within the joints was reduced, the animals redistributed their body weight on the OA-induced hindlimb. In summary, curcumin and FCE possess desirable anti-inflammatory and repair functions, suggesting their potential as alternative remedies in the management of OA or other inflammatory diseases.

A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial Assessing Efficacy and Safety of a Novel Low-Dose Turmeric Extract Formulation in Healthy Adults with Chronic Knee Pain

BACKGROUND

Knee pain causes functional limitations, eventually compromising the quality of life. We evaluated the efficacy of our water-dispersible turmeric formulation (60% natural curcuminoids, TurmXTRA 60N®-WDTE60N), which exhibited better PK profile at low dose (250 mg) than standard turmeric extract, in alleviating symptoms of chronic knee pain.

METHODS

In this randomized, double-blind, placebo-controlled trial, subjects received either 250 mg WDTE60N capsule (150 mg curcuminoids; n = 53) or appearance-matched placebo capsule (n = 53) once daily for 90 days. Primary endpoint was change in pain score on the visual analogue scale (VAS) after 80-m fast-paced walk test.

RESULTS

A total of 96 subjects completed the study. WDTE60N reduced VAS score from baseline (5.4 ± 0.9) to day 90 (3.8 ± 0.8) with greater mean reduction than placebo (-1.5 ± 0.7 vs -0.6 ± 0.8, p < 0.0001; 2.5 times). It also significantly improved the time taken for 80-m fast-paced walk test and 9-step stair-climb test; and improved all biomarkers compared to placebo (p > 0.05). Three adverse events occurred but were unrelated to study products.

CONCLUSION

WDTE60N 250 mg administered once daily for 3 months, alleviated knee pain, improved joint function in healthy subjects with chronic knee pain, was well tolerated and safe.

Angiotensin II triggers knee joint lesions in experimental osteoarthritis

OBJECTIVES

This study aimed to evaluate the involvement of Angiotensin II (Ang II) in joint lesions associated with osteoarthritis (OA) in vitro and in vivo.

METHODS

Chondrocyte cultures were obtained from knee joints of neonatal rats and stimulated with Ang II/MIA/ACE inhibitors. In vivo, rats treated or not with the ACE inhibitor captopril, received daily injections of Ang II or sodium monoiodoacetate (MIA) in knee joints for evaluation of cartilage, bone, and synovial lesions.

RESULTS

Cultured chondrocytes expressed the mRNA for Ace, Agtr1, Agtr2, and Mas1. Stimulating cells with Ang II reduced chondrocyte viability and metabolism. Accordingly, in vivo Ang II injection into the knees of rats triggered hyperalgesia, joint edema, increased the number of leukocytes in the joint cavity, and induced cartilage lesions associated with OA alterations. In further experiments, Ang II synthesis was prevented with the ACE inhibitor Captopril in the context of MIA-induced OA. Ang II inhibition with captopril improved the OARSI score, induced chondroprotection, and reduced the leukocyte recruitment from synovium after MIA. Additionally, captopril prevented MIA-induced bone resorption, by decreasing the number of osteoclasts and increasing the expression of IL-10 in the bone. In vitro, inhibiting Ang II synthesis decreased MIA-induced chondrocyte death and increased Col2a1 transcription.

CONCLUSION

Ang II induces chondrocyte death and joint tissue damages associated with OA and its modulation can be a therapeutic strategy in osteoarthritis.

Identification and Characterization of the Intra-Articular Microbiome in the Osteoarthritic Knee

Osteoarthritis (OA) is the most common joint disorder in the United States, and the gut microbiome has recently emerged as a potential etiologic factor in OA development. Recent studies have shown that a microbiome is present at joint synovia. Therefore, we aimed to characterize the intra-articular microbiome within osteoarthritic synovia and to illustrate its role in OA disease progression. RNA-sequencing data from OA patient synovial tissue was aligned to a library of microbial reference genomes to identify microbial reads indicative of microbial abundance. Microbial abundance data of OA and normal samples was compared to identify differentially abundant microbes. We computationally explored the correlation of differentially abundant microbes to immunological gene signatures, immune signaling pathways, and immune cell infiltration. We found that microbes correlated to OA are related to dysregulation of two main functional pathways: increased inflammation-induced extracellular matrix remodeling and decreased cell signaling pathways crucial for joint and immune function. We also confirmed that the differentially abundant and biologically relevant microbes we had identified were not contaminants. Collectively, our findings contribute to the understanding of the human microbiome, well-known OA risk factors, and the role microbes play in OA pathogenesis. In conclusion, we present previously undiscovered microbes implicated in the OA disease progression that may be useful for future treatment purposes.

Exploring Physical Therapist Adherence to Clinical Guidelines When Treating Patients With Knee Osteoarthritis in Australia: A Mixed Methods Study

OBJECTIVE

The authors aimed to understand how physical therapists used practice guidelines to manage patients with knee osteoarthritis (OA) in Australia.

METHODS

This study used a concurrent triangulation mixed-method approach to explore how physical therapists applied clinical guidelines when managing patients with knee OA in an outpatient setting via completion of a semi-structured interview. Interviews were thematically analyzed by 2 investigators using an inductive approach. Themes were then triangulated to the results of an audit that evaluated the level of adherence to respective areas in the clinical guidelines among physical therapists at the participating site.

RESULTS

One main theme and 3 subthemes were identified from 18 participants: (1) physical therapists were most confident in applying guidelines to improving range of movement and strength; (2) lack of knowledge in prescription of aerobic exercise, weight, and pain management; (3) pain is a bigger barrier in areas where knowledge is lacking; and (4) lack of clarity around the scope of practice. Themes converged with the reported level of adherence to guidelines.

CONCLUSIONS

Physical therapists commonly include range of movement and muscle strength exercises when managing people with knee OA. However, they were less confident in prescribing aerobic exercise and recommending weight and pain management strategies.

IMPACT

Apart from the need to upskill physical therapists in the aforementioned areas of clinical practice, the role of a physical therapist in the management of people with knee OA requires further clarification.

3D biofabrication for soft tissue and cartilage engineering

Soft tissue injuries (STIs) affect patients of all age groups and represent a common worldwide clinical problem, resulting from conditions including trauma, infection, cancer and burns. Within the spectrum of STIs a mixture of tissues can be injured, ranging from skin to underlying nerves, blood vessels, tendons and cartilaginous tissues. However, significant limitations affect current treatment options and clinical demand for soft tissue and cartilage regenerative therapies continues to rise. Improving the regeneration of soft tissues has therefore become a key area of focus within tissue engineering. As an emerging technology, 3D bioprinting can be used to build complex soft tissue constructs "from the bottom up," by depositing cells, growth factors, extracellular matrices and other biomaterials in a layer-by-layer fashion. In this way, regeneration of cartilage, skin, vasculature, nerves, tendons and other bodily tissues can be performed in a patient specific manner. This review will focus on recent use of 3D bioprinting and other biofabrication strategies in soft tissue repair and regeneration. Biofabrication of a variety of soft tissue types will be reviewed following an overview of available cell sources, bioinks and bioprinting techniques.

Osteoarthritis: Pathology, Diagnosis, and Treatment Options

Osteoarthritis (OA) is a worldwide endemic and debilitating disease. Previously thought to simply be damaged from "wear and tear," OA is now understood to be a complex interaction of local and systemic factors. This article reviews the pathology, symptoms, diagnosis, and various conservative, surgical, and novel treatments of OA.

Return to sport following isolated opening wedge high tibial osteotomy

BACKGROUND

The purposes of the study are as follows: (1) examine the timeline of return to sport (RTS) following isolated high tibial osteotomy (HTO), (2) evaluate the degree of participation and function upon RTS and (3) identify reasons that patients do not return or discontinue participation in sport activity.

METHODS

Patients undergoing isolated HTO were reviewed retrospectively at a minimum of two years post-operatively. Patients completed a subjective sports questionnaire, a visual analog scale for pain, Single Assessment Numerical Evaluation, and a satisfaction questionnaire.

RESULTS

Thirty-eight patients (70.4%) were included at an average of 9.0 ± 3.3 years. Thirty-four patients (average age 42.7 ± 7.2 years, 90.0% with a Kellgren-Lawrence grade of III/IV) participated in sports within three years prior to surgery. Eighteen patients (52.9%) returned to the operating room by the time of final follow-up, including 13 patients (38.2%) who underwent salvage arthroplasty by 6.1 ± 3.6 years following HTO. Thirty patients (88.2%) returned to ≥1 sport at an average of 7.5 ± 5.0 months; however only 41.2% were able to return to preinjury level of participation.

CONCLUSIONS

In patients with medial osteoarthritis and varus deformity, isolated high tibial osteotomy provides a high rate (88.2%) of return to sport by 7.5 months postoperatively, yet only a fraction of patients returned to their preinjury level. HTO is not a definitive treatment option as nearly 40% of patients underwent knee arthroplasty by 6.1 years post-operatively. Patient expectations regarding return to sport can be appropriately managed with adequate preoperative patient education.

LEVEL OF EVIDENCE

IV.

Role of nanostructures in improvising oral medicine

The most preferable mode of drugs administration is via the oral route but physiological barriers such as pH, enzymatic degradation etc. limit the absolute use of this route. Herein lies the importance of nanotechnology having a wide range of applications in the field of nano-medicine, particularly in drug delivery systems. The exclusive properties particularly small size and high surface area (which can be modified as required), exhibited by these nanoparticlesrender these structures more suitable for the purpose of drug delivery. Various nanostructures, like liposomes, dendrimers, mesoporous silica nanoparticles, etc. have been designed for the said purpose. These nanostructures have several advantages over traditional administration of medicine. Apart from overcoming the pharmacokinetic and pharmacodynamics limitations of many potential therapeutic molecules, they may also be useful for advanced drug delivery purposes like targeted drug delivery, controlled release, enhanced permeability and retention (EPR) effect. In this review, we attempt to describe an up-to-date knowledge on various strategically devised nanostructures to overcome the problems related to oral drug administration.

A Meta-Analysis of Non-Osteoarthritis and Osteoarthritis Chondrocyte Gene Expression to Determine the Efficacy of Autologous Chondrocyte Transplantation as a Viable Treatment Option

BACKGROUND

Osteoarthritis (OA) is a clinical syndrome characterized by joint failure that is accompanied by pain and functional limitations. OA is the leading cause of chronic disability in elderly and it is estimated that the United States spends $185 billion in management of OA annually. Although OA patients receive both pharmacologic and non-pharmacologic treatments, none of them provide long-lasting treatments. Since 1980s, autologous chondrocyte transplantation (ACT) has been used to regenerate cartilage within focal cartilage defects of young patients without pre-existing OA with increased functionality by 74% to 90%. In this technique, chondrocytes are removed from patients, multiplied in vitro, then implanted into the focal cartilage defect. Our review aimed to compare chondrocyte gene expression profiles of non-OA patients with OA patients to determine if OA-derived chondrocytes could be used for the ACT.

METHODS

An extensive literature search was conducted with following criteria:(1) comparing chondrocyte gene expression profiles of OA joint and non-OA joint, or (2)relating to ACT. Ingenuity Pathway Analysis (IPA) was then utilized to analyze the differential chondrocyte gene expression profiles of OA to non-OA patients to identify key associated biological pathways.

RESULTS

Differential gene expression profiles were similar between non-OA and OA chondrocytes: including ACAN, COL2A1, COL1A1, SOX 6 (p<0.001-0.05); FN1, COL11A1, MMP7, DLX5, SOX9, MMP2, TGFB1, THBS3, COMP, CILP2, ASPN, IGF2, DPT (p<0.001-0.05), and ADAMTS5, LAMA4 (p<0.01-0.05).

CONCLUSION

These genes are important to cartilage function. Therefore, our results suggest that OA-derived chondrocytes may be useful to heal focal cartilage defects using ACT.

Acetabular labrum of hip joint in osteoarthritis: A qualitative original study and short review of the literature

PURPOSE

Histological architecture of normal acetabular labrum regarding free nerve endings (FNEs) and mechanoreceptors (MRs) has been satisfactorily described in the literature. However, the presence of FNEs and MRs in acetabular labrum of hip joint has been analyzed only once in patients with osteoarthritis (OA). Aim of this article is to report histological distribution pattern of FNEs and MRs in acetabular labrum of patients with severe OA, at the same time conducting a comparison with normal acetabular labrum described in the literature.

METHODS

Seven patients with severe hip OA were enrolled in this study. Patient selection was assisted by the utilization of specific clinical scales delineated by the American College of Rheumatology. After successful total hip arthroplasty, tissue samples of acetabular labra of seven patients were histologically processed and stained with the gold standard chloride method, which was subsequently examined under a compound microscope.

RESULTS

FNEs and MRs constituted the major histological structures. Identified MRs included Pacini corpuscles, Ruffini corpuscles, and Golgi-Mazzoni corpuscles. The presence of FNEs was predominant in the middle part of the acetabular labrum, featuring a remarkable decrease in peripheral parts. In contrast, MRs were detected basically in peripheral parts and less in the middle part.

CONCLUSIONS

Differentiation of the distribution pattern of MRs and FNEs in acetabular labrum of hip joint is remarkable between normal patients and patients with severe OA. The abundance of FNEs in the middle part of the pathologic labrum is mainly responsible for the observed discrimination. A "conversion" of MRs to FNEs may occur during OA progression, modulating therefore this pattern as well as the upcoming clinical manifestations.

Identification of key mRNAs and microRNAs in the pathogenesis and progression of osteoarthritis using microarray analysis

Osteoarthritis (OA) is a common type of disease affecting the joints that results from the breakdown of joint cartilage and the underlying bone; currently, its pathogenesis is still unclear. The aim of the present study was to identify key mRNAs and miRNAs involved in the pathogenesis and progression of OA using microarray analysis. The gene expression profile of GSE27492 was downloaded from the Gene Expressed Omnibus database, and included 49 arthritic mouse ankle samples collected at 6 time points (0, 1, 3, 7, 12 and 18 days) following the induction of arthritis via serum transfer. Differentially expressed genes (DEGs) were identified in ankle samples taken on days 1, 3, 7, 12 and 18 following serum transfer compared with day 0 samples, and overlapping DEGs in day 3, 7, 12 and 18 samples were identified. The Database for Annotation, Visualization and Integrated Discovery online tool was used to perform functional and pathway enrichment analyses of the overlapping DEGs. The miRWalk database was used to identify potential micro (mi) RNAs regulating the selected overlapping DEGs, and regulatory miRNA‑target mRNA pairs were obtained. The Cytoscape platform was used to establish and visualize the miRNA‑mRNA regulatory network. The present results revealed that 35, 103, 62 and 75 DEGs were identified in day 3, 7, 12 and 18 samples, respectively. A total of 17 overlapping DEGs were identified among the 4 sample sets, and revealed to be enriched in 14 gene ontology terms and 3 Kyoto Encyclopedia of Genes and Genomes pathways. miRWalk analysis identified 242 potential miRNA‑mRNA regulatory pairs and 211 nodes were revealed to be involved in the miRNA‑mRNA regulatory network. The present study identified potential genes, including C‑type lectin domain family 4 member D, chemokine (C‑X‑C motif) ligand 1 and C‑C motif chemokine ligand, and pathways, including chemokine signaling pathways, cytokine‑cytokine receptor interactions and nucleotide‑binding oligomerization domain‑like receptor signaling pathways, which may be involved in the pathogenesis and progression of OA. These findings may help elucidate the molecular mechanisms underlying OA pathophysiology, and may be useful for the development of novel therapeutic targets for the treatment of patients with OA.

Measuring and realizing the translational significance of preclinical in vivo studies of painful osteoarthritis

In this communication, we discuss some key issues surrounding the translation of preclinical efficacy studies in models of painful osteoarthritis (OA) to the clinical arena. We highlight potential pitfalls which could negatively impact successful translation. These include lack of alignment between a model + endpoint and the intended clinical population, employing testing strategies in animals that are not appropriate for the targeted human population such as pre-emptive treatment and lastly, underestimating the magnitude of the efficacy signal in animals that may be needed to see an effect in the clinical population. Through careful analysis, we highlight the importance of each pitfall by providing relevant examples that will hopefully improve future chances of optimizing translation in the area of OA pain research. We advocate advancing publications directed at comparing methods, outcomes and conclusions between preclinical and clinical studies, regardless of whether the findings are positive or negative, are important for improving the potential for a desired successful translation from the bench to bedside.

A Fatal Sepsis Caused by Hyaluronate Knee Injection: How Much the Medical History and the Informed Consent Might Be Important?

The incidence of Osteoarthritis (OA) is gradually increasing worldwide due to two main reasons: longer life expectation and increased functional demand. Several treatment options have been proposed for this disease. Conservative treatment has the goal to improve the quality of life, reduce pain, and prevent the progression of the disease. Hyaluronate viscosupplementation is one of the most used infiltrative treatments for OA, but, despite its common use, clinical efficacy is still under question. Though adverse reactions for this medical option are actually rare, septic arthritis is a very scaring complication. We present a case report of a 59-year-old man who has been submitted to only one knee hyaluronate injection and consequently reported a severe septic arthritis and systemic sepsis, which lead to the death of the patient. We recommend producing correct guidelines for a clean aseptic procedure of injection to obtain proper consensus from the patient and to pay attention to his clinical history and comorbidities before acting any kind of invasive treatment, including joint injection.

Low-dose SoluMatrix diclofenac in patients with osteoarthritis pain: impact on quality of life in a controlled trial

Low-dose SoluMatrix diclofenac was developed to provide effective pain relief for osteoarthritis pain. We evaluated the effects of SoluMatrix diclofenac on health-related quality of life (HRQoL) measures in patients with osteoarthritis, hypothesizing that SoluMatrix-treated patients would experience significant improvement compared with placebo. In this 12-week, phase 3 randomized controlled trial, 305 patients with osteoarthritis of the hip or knee received SoluMatrix diclofenac 35 mg three times (TID) or twice (BID) daily or placebo. Measures included HRQoL, assessed by Short Form 36 (SF-36, version 2), and pain, stiffness, and physical function, assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline and at week 12. Descriptive statistics were calculated for mean changes from baseline; inferential statistics compared treatment groups with placebo. SoluMatrix diclofenac 35 mg BID (6.2 [0.75]; P = 0.0048) or TID (6.6 [0.80]; P = 0.0014) produced large improvements in the SF-36 physical component summary (PCS) scores at week 12 (least squares mean change from baseline [SE]) compared with placebo (3.5 [0.78]). Minimum clinically important differences were observed in six out of eight SF-36 domains among patients in SoluMatrix diclofenac groups and five out of eight domains in the placebo group; treatment with SoluMatrix diclofenac 35 mg TID produced significant improvements (P ≤ 0.03) in five out of eight domains versus placebo. SoluMatrix diclofenac 35 mg TID significantly improved responses to 23 out of 24 questions in the WOMAC versus placebo (P ≤ 0.0334). Low-dose SoluMatrix diclofenac 35 mg TID and BID significantly improved HRQoL, pain, stiffness, and physical function in patients with osteoarthritis of the hip or knee.

Return to Work and Sport Following High Tibial Osteotomy: A Systematic Review

BACKGROUND

The purpose of this study was to examine (1) timelines for return to sport and work following high tibial osteotomy (HTO), and (2) whether patients return to sport and work at levels similar to preoperative levels.

METHODS

A systematic search was conducted across 3 databases (MEDLINE, Embase, and PubMed). Two reviewers independently screened the results for relevant articles. Data regarding patient demographics, indications, surgical technique, return to work and sport, and complication and failure rates were abstracted from eligible studies.

RESULTS

Nineteen studies were included, involving 1,189 patients (64% male, 21% female, 15% unspecified) and 1,224 knees. Mean age was 46.2 years (range, 16 to 80 years). Opening-wedge HTO was most commonly used, followed by closing-wedge HTO and hemicallotasis. Mean follow-up was 65.4 months (range, 8 to 253 months). Overall, 87.2% of patients returned to sport postoperatively, and 78.6% returned at an equal or greater level. Among competitive athletes, 54% returned to competition. Overall, 84.5% of patients returned to work postoperatively, and 65.5% returned at an equal or greater level. Approximately 90% of patients who returned to work or sport did so within 1 year. The complication rate was 5.8%, with infection being the most common complication; 7.0% of patients progressed to a total knee arthroplasty at a mean of 6.7 years (range, 0.8 to 15 years) following HTO.

CONCLUSIONS

The majority of patients undergoing HTO return to sport and work, and most return within 1 year of the operation. Most patients return to sport at a level equal to or greater than the preoperative level. Approximately two-thirds of patients return to an equal or greater level of physical work.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

MicroRNA-9 regulates the development of knee osteoarthritis through the NF-kappaB1 pathway in chondrocytes

It has been suggested that microRNA-9 (miR-9) is associated with the development of knee osteoarthritis (OA). This study was aimed to investigate the association between the mechanism of miR-9 targeting nuclear factor kappa-B1 (NF-κB1) and the proliferation and apoptosis of knee OA chondrocytes.Cartilage samples were collected from 25 patients with knee OA and 10 traumatic amputees, and another 15 OA rat models, together with 15 rats without knee OA lesions were also established. MiR-9 expressions in both knee OA cartilage and normal cartilage samples were detected using quantitative real-time PCR. The expressions of related genes (NF-κB1, IL-6, and MMP-13) in the two groups were also detected. Dual luciferase reporter gene assay was employed to examine the effect of miR-9 on the luciferase activity of NF-κB1 3'UTR. Knee OA chondrocytes were transfected with miR-9 mimics, miR-9 inhibitor, and NF-κB1 siRNA, respectively, and changes in cellular proliferation and apoptosis were detected via MTT assay and flow cytometric analysis, respectively. Western blotting assay was used to detect the expressions of NF-κB1, interleukin-6 (IL-6), and matrix metalloproteinase-13 (MMP-13).According to results from human OA samples and rat OA models, miR-9 was significantly downregulated in knee OA cartilage tissues compared with normal cartilage tissues (P < 0.01). The expressions of NF-κB1, IL-6, and MMP-13 in knee OA cartilage tissues were significantly higher than those in normal cartilage tissues (P < 0.01). Dual luciferase reporter gene assay showed that miR-9 could bind to the 3'UTR of NF-κB1 and significantly inhibit the luciferase activity by 37% (P < 0.01). Upregulation of miR-9 or downregulation of NF-κB1 could promote cell proliferation and suppress cell apoptosis.Conclusively, downregulated miR-9 can facilitate proliferation and antiapoptosis of knee OA chondrocytes by directly binding to NF-kB1, implying that stimulating miR-9 expressions might assist in treatment of knee OA.

Therapeutic potential of mesenchymal stem cell based therapy for osteoarthritis

Osteoarthritis (OA) is a chronic degenerative disease affecting articular cartilage in joints, and it is a leading cause of disability in the United States. Current pharmacological treatment strategies are ineffective to prevent the OA progression; however, cellular therapies have the potential to regenerate the lost cartilage, combat cartilage degeneration, provide pain relief, and improve patient mobility. One of the most promising sources of cellular regenerative medicine is from mesenchymal stem cells (MSCs). MSCs can be isolated from adipose tissue, bone marrow, synovial tissue, and other sources. The aim of this review is to compile recent advancement in cellular based therapy more specifically in relation to MSCs in the treatment of osteoarthritis.